Alcohol is a central part of our culture and, at low levels, does not necessarily cause harm. We learn from a young age that alcohol is used for celebrations, for toasts, to watch sports, and for socialising/relaxing, amongst many other reasons. It is now so part of the fabric that we do not recognise the association alcohol has with many events in our lives. For many, the association is so implicit that we have forgotten how to socialise without it, myself included. However, most adults drink responsibly, which reduces the impact of harm.
Whilst alcohol is used in conjunction with celebrations and can enhance experiences, it can often border on both physical and emotional harm to oneself and others. As a species, we are designed to avoid physical and emotional pain in order to survive. Unsurprisingly, the avoidance of distressing emotions is prevalent in most mental health issues regardless of specific diagnosis and is achieved in many ways.
Alcohol is an effective way to numb/reduce the intensity of emotions from the mild/acute social anxiety at social gatherings to the relentless suffering that is common in more severe mental health presentations or relationship breakdowns, loneliness, or physical pain. If we have not learnt effective ways to regulate ourselves as children/young adults, we will often resort to alcohol to self-soothe. This is a form of self-medication which, if left untreated, can lead to further anxiety, alienation, physical health issues, and fatalities.
It has been found that having more adverse childhood experiences (ACES) increases the risk of addiction by 2-4 times (Dube et al. 2012). Living in a chaotic, unsafe, and unpredictable environment without an effective and attuned caregiver who is able to regulate and soothe us can be devastating as we learn our emotions are intolerable. In the absence of an adult who can calm us down or cheer us up when we feel mad or down, we will learn to self-soothe/get rid of intense negative emotions on our own, often in the quickest and subsequently more destructive ways, e.g. through substances and/or self-harm. As adults with or without ACES if we have not learnt how to self-soothe/regulate in healthy ways we will often find destructive strategies to effectively get rid of the intolerable suffering. Further, research has found that conditions like ADHD represent a risk factor in the early onset of addiction, with many ADHD sufferers experiencing more severe and prolonged substance use disorders. It is possible this is a risk factor for many neurodivergent people trying to cope in a world designed for neurotypical people.
When Professor David Nutt (cite 2) reviewed all drugs in the UK, he found alcohol to be the most harmful. The findings showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals, whereas alcohol, heroin, and crack cocaine were the most harmful to others. Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places. However, one must be mindful when reviewing this graph as it does not consider a drug’s legality, accessibility, or how widely a drug is used. See graph below.
At Klearwell, we recognise that alcohol addiction is a symptom of something else, a result of self-medicating low mood, depression, or anxiety, which is often, but not always, rooted in trauma. The Ketamine for Alcohol Reduction (KARE) treatment is the world’s first evidence-based ketamine-assisted psychotherapy. This may seem counterintuitive, given ketamine can also be a substance of harm. However, we use medical-grade ketamine, which is the same ketamine that is used in hospitals for surgery or in A+E. It has been found that low doses of ketamine can profoundly enhance the brain’s ability to grow new neural pathways, encouraging a new way of thinking about problems. In the treatment, we utilise this enhanced creative state that ketamine provides, alongside an adapted but established model of psychotherapy, to help people find ways to overcome and move on from their problematic drinking. So far, it has been shown to be an effective treatment to overcome alcohol addiction. This highlights that it may not be the substances themselves that cause harm but rather the amount and the intention behind their use.
However, the decision to drink less or not at all cannot be simply reduced to those with disordered drinking habits or unresolved trauma. There are myriad reasons why people may drink less or not at all, for example, pregnancy/trying to conceive, driving, important work events, surgery, epilepsy, ageing, and choosing a healthier lifestyle. My partner, who, despite no Irish blood, was indistinguishable from an Irishman for his love of Guinness. He was able to consume large quantities of alcohol every weekend as part of the social and cultural norm. And, as an otherwise healthy thirty-year-old man in his prime, his alcohol intake did not impact his life, so it remained unchallenged. This was until a sudden and unexpected diagnosis of epilepsy at age 30.
One of the most common triggers for epileptic seizures are alcohol and lack of sleep, and those who suffer from serious alcohol addiction may experience seizures from alcohol withdrawal as it is when the alcohol is leaving your system that the brain has to work overtime to rebalance the neurochemical changes that occurred when consuming alcohol. It is when the brain is in this hyper-excitable state that people are vulnerable to seizures. As such many people with epilepsy have to reduce or monitor their alcohol intake to manage their seizures, often alongside anticonvulsant medication. The cornerstone of this sudden transition for us from alcohol-heavy to alcohol-free weekends has been the introduction of alcohol-free drinks which have improved in technology so it no longer compromises taste or quality like the alcohol-free drinks of old.
From a quick search of ‘alcohol free options article’ on google we can see there was a 5000% increase in articles in 2023 compared to 2019. We know from COVID-19, there was an increase in alcohol sales, but there was also an increase in non-alcohol sales, which may simply reflect only being able to drink inside at home. The existing UK threshold for alcohol-free (0.05% ABV) is the lowest in the world, whereas the vast majority of markets define alcohol-free as 0.5% ABV. However, Guinness 0.0 was launched in 2021 and is said to be the top-selling non-alcoholic beer in the four-pack format in Great Britain. Bar sales continue to show an increase of sales which has grown exponentially at 23% last year compared to 9% the year before (cite 3,4). According to a recent study by the National Institute for Health and Care Research, no/low alcohol beer is favoured over other no/low drink choices by 77% (cite 5). The fact that there is a continuing rise may reflect a preference change that will be sustained and therefore normalised, which is encouraging for those who are ‘sober curious’.
From someone whose birthday is in January, the only thing that could make the darkest, coldest, wettest, and poorest month of the year worse was the introduction of dry January – the antithesis of fun. However, as I grow I am seeing there are alternative ways to celebrate a January birthday such as a spa weekend (SAUNA), or a fancy dinner. Maybe it is the millennial in me talking, but I would like to live as healthy as I can to be as fulfilled as possible – this may include an occasional drink, but ultimately, it is about the choice. I encourage you to challenge your prior beliefs that you need excessive amounts of alcohol (if any) to have fun or be silly so you can see it to believe it.
For those of you who recognise you have an alcohol problem and have tried rehabs and detoxes just to return to the drinking cycle, we would encourage you to use the supports around you, including friends and family, alcoholics anonymous, or other support groups. If you are ready to finally put an end to your drink cycle, then please look into our KARE programme here.
For those in urgent need of care; please make an urgent appointment with your GP, contact 111 to locate your local crisis team, present at A+E, or Call 116 123 to talk to Samaritans, or email: jo@samaritans.org for a reply within 24 hours. You can also text “SHOUT” to 85258 to contact the Shout Crisis Text Line, or text “YM” if you’re under 19.
References:
- Dube SR, Anda RF, Felitti VJ, Edwards VJ, Croft JB. Adverse childhood experiences and personal alcohol abuse as an adult. Addict Behav. 2002 Sep-Oct;27(5):713-25. doi: 10.1016/s0306-4603(01)00204-0. PMID: 12201379.
- Nutt, D. J., King, L. A., & Phillips, L. D. (2010). Drug harms in the UK: a multicriteria decision analysis. The Lancet, 376(9752), 1558-1565.
- https://www.nihr.ac.uk/news/new-report-reveals-key-features-of-no-and-low-alcohol-drinks-market/35228
- https://www.psychiatrist.com/read-pdf/12522/
by Rebecca Samuels, Cognitive Behavioural Therapist at Klearwell.
